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Department of
SOCIAL SERVICES

Community Care Licensing


FACILITY EVALUATION REPORT

Facility Number: 191871007
Report Date: 03/09/2022
Date Signed: 03/09/2022 03:16:09 PM


Document Has Been Signed on 03/09/2022 03:16 PM - It Cannot Be Edited

STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

FACILITY EVALUATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
CCLD Regional Office, 1000 CORPORATE CENTER DR 200B
MONTEREY PARK, CA 91754



FACILITY NAME:CHILDREN'S COLLECTIVE, INC. THEFACILITY NUMBER:
191871007
ADMINISTRATOR:CHENIEKA MORGAN-MILLFACILITY TYPE:
850
ADDRESS:3817 S. SAN PEDRO ST.TELEPHONE:
3232311367
CITY:LOS ANGELESSTATE: CAZIP CODE:
90011
CAPACITY:48CENSUS: 23DATE:
03/09/2022
TYPE OF VISIT:Case Management - IncidentUNANNOUNCEDTIME BEGAN:
11:25 AM
MET WITH:Tameka DeVine, Site SupervisorTIME COMPLETED:
03:27 PM
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Licensing Program Analyst (LPA) Mayra Rivera conducted a Case Management inspection to follow up on the self reported incident that occurred on 2/24/22. LPA met with Site Supervisor Tameka DeVine who guided the LPA on a tour of the facility. LPA observed 15 children with 3 staff members from room 1 outside having lunch and 8 children with 2 staff members in room 2 having lunch.

During investigation, LPA interviewed staff, reviewed staff and children records, and obtained a copy of the roster. Based on inspection, interviews and documents received, at this time additional information is needed prior to determining whether or not a violation occurred.

A notice of site visit was given and must remain posted for 30 days.

Exit interview conducted and report was reviewed with Site Supervisor Tameka DeVine.

SUPERVISOR'S NAME: Karen ChambersTELEPHONE: (323) 981-3368
LICENSING EVALUATOR NAME: Mayra RiveraTELEPHONE: (323) 629-7782
LICENSING EVALUATOR SIGNATURE:
DATE: 03/09/2022
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:
DATE: 03/09/2022
This report must be available at Child Care and Group Home facilities for public review for 3 years.

LIC809 (FAS) - (06/04)
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